The relation between viscero-abdominal disproportion and type of omphalocele closure.

OBJECTIVE

To investigate the relation between prenatal ultrasound measurements of viscero-abdominal disproportion and the expected type of postnatal surgical closure of an omphalocele.

STUDY DESIGN

Retrospectively, 24 fetuses diagnosed with an isolated omphalocele in the 2nd trimester of pregnancy were selected (period 2003-2013). An image of the axial plane of the abdomen at the level of the defect was retrieved. The ratio of omphalocele circumference to abdominal circumference (OC/AC), and the ratio of defect diameter to abdominal diameter (DD/DA) were calculated. Prognostic outcome was primary closure. Sensitivity and specificity and the corresponding area under the ROC curve of these ratios were calculated as measurements of prognostic accuracy.

RESULTS

Primary closure was achieved in 15/24 cases. For the OC/AC-ratio a cut-off value of 0.82 successfully predicted outcome in 23/24 cases with an area under the ROC curve of 0.99. A cut-off value of 0.61 for the DD/DA-ratio successfully predicted type of closure in 20/24 cases with an area under the ROC curve of 0.88. In all cases without eviscerated liver tissue, the defect was primarily closed.

CONCLUSION

In prenatal isolated omphalocele cases, the OC/AC-ratio is better at predicting postnatal surgical closure than the DD/DA-ratio and can be used as a prognostic tool for expected type of closure in the 2nd trimester of pregnancy.